Diabetes Screening
A new Lancet study had researchers looking at the number of deaths over 10 years among more than 20,000 people, aged 40 to 69, in England. All of them were at high risk for diabetes. The patients were divided into three groups. One group underwent a round of diabetes screening that was followed up by routine care for those diagnosed with diabetes; another group had a round of screening followed by intensive management for those diagnosed with diabetes; and a third group did not undergo diabetes screening. Over an average follow-up of nearly 10 years, the overall death rates in the groups that had diabetes screening were no lower than in the group that had no screening. There also was no significant difference between the groups in the number of deaths specifically from diabetes, cardiovascular illness, cancer or other causes.
I know these results seems counterintuitive and it is just one study but 20,000 people is a lot of research subjects to look at. What if it is right? Would our government and insurance companies heed the new recommendations? There are bogus quality indicators that pay doctors who screen such measures. If screening for type 2 diabetes does not appear to reduce the risk of death in the general population, it would make this performance measure obsolete. One more reason that P4P, quality initiatives, and benchmarks are not good for healthcare! Doctors need to be allowed to treat patients as people and not numbers. You cannot industrialize medicine.
To Pat Nagle–You “gather” wrongly–the study states that the groups which had screening, regardless of whether they were then followed by routine care or intensive management, had no change in death rate over those never screened. What would make sense and be expected as the outcome of the study, and which you presumed to have “gathered” from the report, is the exact opposite of what was found.
Another example of how quickly people see what they expect to see and presume that it is just there and go on believing whatever they already believe.
I gather that the group with intensive followup did better. Perhaps that Tx motivated them to follow their doctors’ advice more thoroughly than those with just screening or routine followup?
Here is a great video about overdiagnosis by G Gilbert Welch. He deals mostly in cancer overdiagnosis, but I imagine the same problems arise in many other diagnoses as well.http://drmcdougall.com/video/expert_testimonies_h_gilbert_welch_over-diagnosed.htm